Healthcare Provider Details

I. General information

NPI: 1336628569
Provider Name (Legal Business Name): KEFALOS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/08/2018
Last Update Date: 04/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1227A 150TH ST
WHITESTONE NY
11357-1747
US

IV. Provider business mailing address

1227 150TH ST
WHITESTONE NY
11357-1747
US

V. Phone/Fax

Practice location:
  • Phone: 347-732-4772
  • Fax: 347-732-4532
Mailing address:
  • Phone: 347-732-4772
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number057429
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State

VIII. Authorized Official

Name: MR. DIMITRIOS LYMBERATOS
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 646-476-1881